BILIARY COMPLICATIONS AFTER HEPATIC RESECTION - RISK-FACTORS, MANAGEMENT, AND OUTCOME

Objective: To identify the risk factors for the development of biliary complications after hepatic resection and to evaluate management in r elation to the outcomes of these patients. Design: Biliary complicatio ns are a common cause of major morbidity after hepatic resection. A su rvey was made of all patients undergoing hepatic resection at 1 instit ution. Perioperative risk factors related to the development of biliar y complications were identified using multivariate analysis. Managemen t and outcome were analyzed also. Setting: A tertiary referral center. Patients: From January 1, 1989, to October 31, 1995, 347 consecutive patients underwent 229 major and 118 minor hepatic resections. Main Ou tcome Measure: Development of postoperative biliary complications. Res ults: Biliary complications developed in 28 (8.1 %) of 347 patients; t hese complications carried high risks for liver failure (35.7 %) and o perative mortality (39.3%). Stepwise logistic regression analysis iden tified increasing age, higher preoperative white blood cell count, lef t-sided hepatectomy, and prolonged operation time as the independent p redictors of development of biliary complications. Conservative treatm ent or nonoperative measures alone, such as percutaneous drainage or e ndoscopic therapy, were effective in treating the complication in 13 o f 19 patients, but those who required reoperation had a high mortality rate (7 [77.8 %] of 9 patients). Patients with demonstrable leakage f rom the common bile duct or its bifurcation tended to have poor outcom es. Conclusions: Biliary complications are a common and serious cause of morbidity after hepatic resection. Preresection cholangiography for finding biliary tract anomaly is recommended before left-sided hepate ctomy. Although nonoperative measures are the preferred approach for s elected patients with biliary complications, those with demonstrable l eakage from the common bile duct or its bifurcation have a grave progn osis and may benefit from early surgical intervention.